HomeMy WebLinkAbout1611 HEALD AVE_ (2)
CITY OF LAKE ELFINORE CONSTRUCTION PERMIT j
Project Address -f�i - �X'!-E ` --- --� Applicant to fill in all spaces except those within heavy border fines and sign all appropriate declarations
Assesso:'•oorc(,INo. -___---f1 p'µ�"r�;��s PER)OT N0. TRACT NO. i LOT N0. UNIT N0.
' �i61> t�. b'-Yr 1-Phc+ne ��
iOs.n±r's Nam✓��-•J-ILA- - - - --- ..
Adorers TYPE �• NEW DD ALTERATION REPAIR
/;�� A.P. ## tune
Arch En ( LL License No. - ��NVERSIO.: OEMO!ISH 01HE9�� Accessory Building_ -
g-- —---- __-__---- DESCNIPT10110F WORK/USE OF L' _�n['ce E! Main Building= -- Z
Phone_- t/ T></% vx% T Front N
Coectdr's Nlp
ame-_- - T11PE OF PERiA1T GR:0lNG l ! FO QAT•Ok .:� REfk tURAL --!t
Aoir s Imalhn ` -- TENANT ! fIECfRICAL PLUMBING YECHANIC111 l 1 L'(� Y G " A Rear N
ig.__— -_-- - - - - -
1 t,tY '_Icnse No. - ------ - - -- OTHER -- - C Right G
PRGIECT t)ESCRIPlIGN.' St:Ft -law; v` ''a'''y - K-------
LICENSEQ CONTRACTOR DECLARAI'IGNte� S Left R
' i nrreby a join that I am licensen under Provision'of Charter 9 rccrnmenung `- Line I E
sectlorls 7060) ut Dlvsron 3 01 the Business anrJ Protcssians Code.and Ca'istruch0e type ,,,.p.. - - �� _ Ping. Ref. - Parking Req IProvided i Q
f m. +,cease is full Inrce antl effect. Valuation$ Stu -PC#
license No. v „, �p� , Plannmy Nate, _
L•cense class '\thl
Remar'x, - -Date ,gnalure ---- --- 1+- S
WORKERS'Cr a Certificate
TION DECLARATION i r; y -_ :- :- ,-- + jQj i rE�'`Tit 34 AttsI herby aff.rve a certrf:cale of COnSenl!o SCl1 opy thereof (Section OF %VdrkGrs' lon insurance, or a certifiedcopy I i 3800, tab. C NU. ---- Companyietlllr•d cby furnished_
i el-0Ihrd eoDY is Illc�with ttie city Building UIVIS�On. T- -•_-__---_ - _
Data _ file_ APD.rant- _---- � L�ri!- �-=, �- - - - -
EXEMPTIrsN FROM ERCOM i NSAT:ON DECLARATION _ _
i EXEMPT' co ulc�cfljf the rime s for one nuntlr&4.ISt0o)or MECHANICAL I GETS ACCT A^ @RIIDiNGFEES
l ,es.•. wo't r• ch this Perry7lt r,rssucc,I - _PLUMBING-- _�Fjl:ES_ _- _ELECTRICAL FEES -r--I crrt,ls Ll,ntnI file nc �1 _ -- cuyard<_r t, a-,to oecrmc-sublect-tn ; Generator -0�KW rl 5-15KW I BOderCutspa'; nr;.t rn,pluy any Person pp an . Alter R^_Pali4vs n'( Cautn ,� ----.� --` i -'; Quct•Under Ground _ F;(; -_-- -- ---- ❑j yards
Date _ - srgr,aF�,rC �F \7 J Auto Wash �- Cnnstruct:hn Pole Sub. ---.--- 1- - -
NOTis,E:lr,srtc, n,a6 n,g It", dee(ardt�u1�Y"u s1,ouW hecoTc suh)CG to-the -r------ DUf i-SlrUtaUfal t- _-
l Cooklna Jolt r 71 ::360-J310 Plan ChecF.Fec S
Wnrkcrs• CuninenSa!lu I Provrsrpnt�n! the L.ab•>: C�us, You muff lo•thr:�th �_-. - _ - i _ ! Fan •VPntifatino __-_. S - -
.(mP•IN w�R, SUCh Pf,1�''S,nns �„ 'ims Percut st.31! be dveme0 revoked, _l BBCkflOw Prevent pole L=•lit [ --� 3300.3312 Permd Fee ---
CONSTRUCTION LENDING AGE Backflow Irriga!IOn .__ _3_.------ �; Exha.Ist S•'stem �--- - _-__-
I nrrrU) affirm chill !here�S a f...nitr u�t In len(hng.r7ency Ire the performance. -- -- Dt';ors-Gas ,._:Electric -- -� - -- Total Fees f
I n• the work ,I sen�cn tars per is issued (section 3097 Gv. C-) �', CIBGtier, '--- - --•-----^ - Ev_aprlative Cooler -
- - --.. _ �.�--_ ' Dishwasher � - M Fan -�-_ - -
Lende,% Na-le -i1 A.U. -�Henan,System&Opcting 1
L ,dr•, s nr•hess -- Fixture Traps ea. - -� ;0100 000 BTU 100.000 BTU i
pWNER GUILDER DECLARATION �;flor Drain Flxlures _ - --� '-- t-•- 33003312 Summary ofPclm+thes
I I nerehy allow, that I am exempt Irr�m th,: �prtt,atll:r'S Licenr- lAn tit me --_ ---^-- -- - --
• r.rwrnn rra•.on ($!`:Iron 7031.5 BUS-ncSS and�,•.,tesS�nn.il Cote: ,cloy city or O1ltlels Hood or Canopy
- Floor Sinks -� ----- ��5' _ Budding S J - t'
county watch requires a permit tq construct.31fhr.14 a APPI e,It for Suc nr repair - - !Swil[he GU I�[1� T/Plc 1 �' Type II _- �-
Ianti tl•utturc,M,or to ai rsuance, also renunesyhe aPPlrtaat iur Such permit I Gas Service. Outlets I Refrigeration System PIulPbing S _.4>J-r-.- ,
t.� tun ,,srgoctl slacc.neol that ne sac is foC<<i5,�tencih�r�,itlitn$ekinpn�000) off -r- - _ , Meter up to 200 amps _._�_____-- 4 J 4 —
tne COnlydCfnr'S Uccnsc L,w tchdpml 9! Interceptors ---.- I ❑0.100=000 BTU�':OQ000 BTU `•�'
Dv,Srun J nl Iho fP.usmeSs anti Professions Cotic) o 'hat hel;he :1 e�xemDt `ry deter over 7.00 amps _ _ - Eiect'Ical f --�.=-
!neretrom and the basis for tt.c anegeo exemption. AAV viotat„ia of ct,00 -T ---- Fife IlFact.Bf'. 1CBO C
I 7031.5 by a.lY aPPncanl for a PCM`11i �blect; the\,tppHcant'to a uvd ;r_Tf8F1- --' -! SUb anel -.----=---- ---- Metnanlczl �-
enaltY nl net more than Irve nuntlred dollars(s`,00). Roof Dfa!rt, -__ I-.�--_---••------ `- - - - _
�, D 15.50KW ��ysu:m Reoairi Alteration __� Other $
-
. i, as nsvner of the Prnncrly nr my ern r+IgycCS with `kJq^-s as the'' sole -1-- .._--
7raaer Sewer Transformer - r
eomPensltion, unP tlo the woos•any) the Structure v, not m1@ntlra nr ,+tercet _ File Dampers
-r- 110131 SfAIP Res f - •.••__-J,�--
-}--- --- - t� 50=KIN --- -1 _- ---_-- ------
fnr lie (Section J044, BusmctS once r':nfcss.ultat Cntic: The Contractor's - _-- _ I liegl,tel'S,. •___-�� ` - _-- .--
Lire R 1�'N tlncs not aPPly t+,do nwncr of a PrUPWY•at' ,hostess or+n,Prnves Sewer[sap - n 1 HP�'.1'/r•$ - I IG•232 SMIP Coin T
Sewer Connecllon Bldg. Motors - 0 ;-
rrern, and who ewes Such wnri, hrl»self,herself nr through n1T'%l nor for
--?------ ---1------ --� -�Incinerator
±m DIOYEM, Pr Hurtled that such grtPNwC.,,enls are.. riot inform Oy) nr bfitrerl fnr I ---__._- -• + ` Inc. Sofa"`_19.15 HP L3lfi•15i - ._-_---- -
,alc. If.howavel, lne huotlm,l nr,mPn,vu•neot is sold-In,,one year•,I core- -i_So!ar_Colleraors_--- -- -.. _ ------------ Mlsc. _.___.__..
_ _ -� 1-_.__- :i36a 3370 Semmary of Plan Check Fees
pletion,the (wirer volt aavc cite hoiden of prnvirg he/She.ditl nnl booth or lfit• -}_Solar Piping _ - _ Sing.Fain. ties. _ ;__._.. - ---------.--
OrOVe fur the par POSe of sale). - - -_-- -. -'�-ulfi-F.- _-.-_.-'-•. _--..-_.-.--._ _,_(,__� S �y_..
I,as owner of ulc p,operty,an, excl„si iy c•Inirac!In.y wan Iicrnsetl con - I Multi•f•am.Res- -�. --•- -- 1 Budding f
tractors In construct l::e project(Scctlnit 70a•1,B,Is,nesS ano ProfeSS�ora Cry)C: Solar Tank__ - TSWlmmin Pews/S a -
- t--- - I__ . __---------
TnC Co ntraclnr's L,:ensc l sows does nnl .IpPly to an nwncr ,if property witha vitro '- `Ll -•,-_,- _ t'� Plulhh�ng f
_l-.cam-- — - 1 issue
T')!, ur a:,pr owes Iherrgn,antl who inn Vac•$for Sutlt pTnfatam aiw.t 0 that 5L'7lmmin P001/Spa _...- -.-. �',-� __ __I_.._.____ --
ttactnr(SI license Pursuant tp file C.ontraCinr's 1.1 Cerlfe Law). Water Heater �. Electoral f _
proof (, their VI or1•ris CnrnnehSation Insurance Snould be. prnvttletl to me. __l ^o �-
am exempt undo, section - •-•- - D.L P.C.fnr this reason I'Hater.Z_rvice �. `?-0.... Mecnamt.al f
--- Septic stem Other S
rc)wnar � - ____- DEVELOPMENT SERVICES REQUIREME?TS: _Date -z % '��t J (.f.-sit of t�1SG�------ Zonfat Ayptttrad i►_.-. 3360.3315 Flamm�g $
l aerehy certify Inat I �IavE read this app!rcatlhn and • ale trial the abuse -- -- ---_date �� /L
Inl orrnatlon is correct. I agree In rumply with all city ano county ordmancoi -tI ___-- BoiWilktW�811 _-, /s, _ .._......- --. /`��r
and state Wws relating In hooding Cunstrurrtun,alto heleby authorize rep{oi --}--•�--'. -/' -__..._^--,Date _ �-�/-G `• aC
nta Uvos q1 tn�s city to
for IIPOIt Iho abo'c•montln r,ed PrupertY - - __ - 1 -F-- flpplKation l•JSaed Bf �(-` -V Total fees Due S --
se ^-� y J I
FI inspect,In irpasot. ^l UalO for�_C~-� Issue -- c S•
S:gnalme a.�„Q�.►1.tSL.- 1 __. ..
1}i L`rwers' License nr SS r _
While-Building. Green-Temporary File Ccpy:Canary•ASseS<01. Pin pplicank Goldenrod•Acumnting
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CITY OF LAM ELSINORE
BUILDING DIVISION
O W N E R -
B U I L D E R V E R I F I C A T I O N
fired to give notice pursuant tO
or county, which is required as a condition precedent
A city and,
shall attach to such notice,completion and require the return
Section 19830, attach
require the comp
to issuing a building perm.,
of an owner-builder verification.
Attention Property Owner.
An "owner building permit has been applied for in your name
r signature. No bui a pe--wit gill be issued until this
and bearing you g
verification is recei _ or labor and materials
personally plan to provide the major
1. I F � proposed property improvement.
for construction of ..he p P
JzYes No
�aveiha
signed an application for a
2. gev not) � ropc$ work.I permit for t. e p P y
I have contracted witb. the following person (firm) to
3` G nstruction:
provide the proposed -
Name , - --
Address Contractors Lic. #
Phone ( )
I plan to provide portions of the rto�•k, but I haven iced the
4. cordinate, supervise, and P
following person to c
major work: n //
Name � - •
Address Contractor's Lic.
Phone (714)
will provide some of the
wrovicbuthe work indicated:ontractees
5. I the following persons P e of Work
(hired) Ad� . Phone Tom- —
Name ---
fired attach subcontractors list.)
(If add ional space is re qu' of the information set
affirm that I have received a copy Safety
Code
I hereb's a State of California theltbestndof my personal
forth in Sectiolete83thef apVe information to
and have in complia.ilce with this State Law. (�
knowledge, Date:
Signed: k-- Jc',- —
Name:
(Print-e��� Type )dd
c: #
Drivers Lic. # or Soc. Se
ON
CITY OF LAKE ELSINORE CONSTRUCTION PERMIT /
Project Address(lD�(_�t_��C�CLlt�--- •. - ---------- Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations L -
Assessor's Pcrcel No. _ --- - --- P IT NO 58 TRACT NO• LOT NO. ! UNIT NO.
i t?v.r,ef's Name �"r AQiaVN9--1` I`% P--Phone
I Address TyPEaFCORSTRIlC1101! NEW .� .- ADD A.ITERAiIOn REPAIR I n¢
! Arch Eng._ ----- _Licens_No - OONYERSIO4. - DEMOLISH OTHER �-r� A.P. #'
' Acid.ess -- DESCRIPTION OFri•ORx'1lSE Of BLDG, C,It� - S Main Building: Accessory Building:
Car.trattor's Name _ _Phone _-- - i Z
TYPE OF PERMIT � tAUtNG FOIINDA-00N - SIRUCTLRAL T Front _ O
Adcress'rnarhna! --- ------ P �
TfNdN1 "7 EAECiRICA1 LUMB!NG i MECHA7rICK A Rear
C ty L•censr_ flu. ----- ------- - OTHER - C�fight i N
LICENSED CONTRACTOR DECLARATION FRO'ECTOfSCRIPT1ON�t Sd:Tt _ -Occupancy - _ - ----� •--- ')G
1 !+eGy Jtlrrm that I am Itcensad under provisions of Charter 9(commencing .�5 �- - S Left i
x,: secer If, 7 that
o+ Division 3 of the Business and Professions Code,and Construction type• LQn2 _- P
,n furl fore?and effect. valmllon f�a1cL4;--- -PC>t - - Ping. Ref. Parklh Req-iPrevidet: E
L.erse ass -_----- Lrcensc No.--- _ --
Da:e __-- signature _- --- Remarks __ %y' 1" S'C. _ Planning Notes _ �� � __ Fw
r WORKERS' MPENSATION D C RATION '-��'t3 1,. -t, - / LU%�iS9 I13�A ( i���4 Il'? __�T
1 re+ety affirm t 1 have d) l ,c?I !consent to self-Insure Or a CCrtiticite } .1r = . �C.r - Y - CITY S
D I-L C1 �o L4I!6 I
o' .varnas' Com nsatio Ir ra e r a certified copy thereof (Section -(_ � �,,�,r��
3SOO, Lat. C.) !� (10 - .. - _ kCPT11:Q2-04�
Pgl.c, N0. Company .L�f(.r r - -
,�, CCr lrt,ea Copy it hereb furmthed.
Cer',ified copy is!ilea w, the City Building,Ctvtvsn_ - - - -
Dace -_ AP ,cant --
t_XEMPTION FROM WORKER COMPENSATION DECLARATION —•-
(?n�S:e:U7n,Iced nOl be CompleM ,f the pC.met 15 for tine hunC r c d(S1001 GI - -
ICSS,.
:e f. t!,a! ,n the oc+'••n•lance nl it :ot;. ter•::nc.t,•h,s Perm•:is rsst:cd,I -`PLIiPABING FEES ELECTRICAL FEES ___MECHANICAL
FEES ACCT 9 GRADING FEES
Sr a '1.'. er,p'oy any petion in shy m u-r So as to beCOme Subicct 10 thJ_
Yr-•.^fs'a_ompehsahon Laws ul Gl:enrnta. ' Alter, Repair _ ; Generator C0.5KW a 5.15W.', - _ —Boiler______ _ C.:t-. _____ Cu.yards
Dale -- __- .S.goaturc putt Under Ground _
-� - -- -,
--s - Construction Pole Sub.
NOTICE:n,jiler makwq tn,s declaration,you ..rn beCnn,e surrect to the'_ Auto Wash _ __—:.-.- i F,ti �U yards
'.7^••n: Compensation Pf uv,sinns of the Lahor yvu .lust fn:thwith COOktJ Unit DUCFSirIiLlLral _
cc --I r :ucn prr,v,s,u s or this permit shaV`n, icenien revolrSd. K2CkffUWPf¢)t¢nter -�_ __�-_-- -t - 33FC331F P'3nCteckFeef -
CONFTRL,JCTION LENDING AGENCY Backflowlrtioation I Pole Li- fan •Veniilatin�_ _-
,rerezr artr-rl,In.11 three H a contiruci,nn :ending ay^Cr:CV the performance ---t- - -,_ Exhaus'_S Slem - 33UU-3ii2 >'erm,I Fee T --
(;f ••, wJ•F fin which tars perry„c is issued •setl�nn o97 crv. c.) Clarifiers { , Dry¢rs f�Gas �Electrtt _ _y
_ Eta nrative Cooler iotai Fees f _
;,r��er s Navrr ------._-_--------------- ----- F.Gas
nfastier Fan _-_ �'orat ---
u. :,. ,,re:t __-- ---- -- • _, T_Heaiin S stem&Ducting
OYL\ER'BUILDER DECLARATION _mTrapsea. IS _ I_F.A.U. g y
-.r er., atf:,nt that I an,I, emol 1rnh, the CoT,t,.jC-,,'S LJCCn SC Law for ther DfaIt1S Fixtures ' $ i �0-100.000 tstU�i100,000 BTU'
-a rta.on (Serra>n 7031 ', BuS,nes and t•r,fessn.�r.st Cock. Any city or 1__--- .--- t-'-- - - 3100.3111 Summary of Permit Fees
•vnicn rcowtes d nerinrt b1•.Onstruct,-IlCr,v,lp':]VC,nCm01i5h nI rcpa�rr Sinks ___.1 Outlets 7 �r� _ Hood or Canopy
a^s S' uau•e.Fr nr IO n5,:Su once,alit,tCnu rCs the apPl r.an; fr•r Such pC/mil J ! t
:o e a signed statement that hc-:tin ,s n,xrse pursuan: :n Inc pruws,nns ref• Service Outlets $Witches - �_ � Type 1 �_ Type Il .__ Building
3 _-_
�ntrat:or's LICem.c Law (ChaPler 9(comment mq v,i;n 5ecttdn 7000)o+ teptOrS _ Plumbing -
G 5 cn 3 )' the Business and Proless,or•t Cudc) or that he/Snc ,s QYCM01 Meter L.i up l0 20rJ amps Refrigeration System i —
'here'for, and the nasis for the alleged exCmponn. Any v:nla;,r+•, of Section Meter(-i over 200 amps , _�0.100,000 BTU E 100,000 BTU ' __. Electrical
7•)3i.'., cr any applicant for a fierm�I s mlcctS the applicant to a civil P•Trap _ - - - -- -
�lralty of not mote than five hunarcn nnnars(i;n0)• - - Sub anel __-- '_ -__ Fire Ilfala.Blt.IC80 = __ _ __
-'�,, Roof Drains p______. --p ------ Kecnanur i
ff as cwner of the prnnerly �„ my cmp�oye.1 w.IrI ;,ages as tor.:, sole Trailer$¢NT.r E'. 15.50KW^ System Repair/Alteration -t--,• __ L J
,C%TOenSdtion, w,u do the whit.,ana the st,uft are �: not mlCnded or Offered --_ _ Transformer ` -- - -'-� Otter
sale (Section ]Oa4• BnHnCSs anti Pr01esS,Gn.:1 Cndc• Tne Cnrir rinr't r_ _ - 50-1KW Fire Dampers _ _ __
L�ct'•Se Lav, lines n,,I appiv to Jn• %tie,Of a pt='arty :vt:o nu,IdS Or improves Sewer Gap`__ _- _ - -- _--�-- -_ _- _-..
-i Motors Cl 0.1 HP 1�7.8 Registers l I0131 SMIP Res S _.
.`c•e0r, anG why, lines such vvn/I• r.,m:clf,""felt ,r tnrouc'; "Is Of Der uv,It _Sewer Connection-Bldg. - _____.— -- -
(+ 111-, or^--es, prOwacu teal such, -)mnrnvemcrits are r,G: mach:n or offered for .j -__ _---- __- -----t• 11013i SMIPCom $
yt!c. if,rawcver, thr I'll am,f or tn,pn,vr.nntn; 4"Irl v.1thrh One year of corn- I Solar Collectors i T _ Inc_Solar 1.79.15 HP',16-6i - - incineratOf-- —
-.n,the Owner will h.tvd the nuldQn n1 tiro Vinci hC/s••n Din not build or'i0- Misc. -_
OrpVa'Or:tic Purnn:a of tale) Solar Piping -j�' _ Singi Fam. Res._-__•.__� _ ----- 33603370 Snm!naq of Plan CAack Fees
as r,wner of the p-pray,an,e,eUus.vC+v c,..ltract,nv :f. :.cenaeo con• - Solar Tank -___.~- Multi•Fam. Res. __ _. _-__.___.._-- '
'•a C:4ri to COnarur.e ILr ur,ggct (Sctann 70.1•;,3•Su1CSS ana Professions Coda' - -- _ - , - !- - - - - --T-- 7Y .`._�.-
T'+e eontraclor's Ln.,ns, Law dues nut apply to an -on Of pmparly wnu Swimm_in P001/^ a -��-- SWimmin PoGI/Spa -_--_-L Budding -.-
nu,ns Or rm.Pr nvec Ihrn-or,anti v.no crinvaclS for SUCK p• Beefs With a Cnn- �y JP— - -�__&_ —
Uact Or(S) IitCniC pursuant to the Cn nl•actm'S Lio±tire 1_av,l- I am aware InaI r - - lssue -__—_ __� Plumbtng f
pr0o' w tile,, wntt,er•s Cnmpensal,on ,nSuran Ga should ne provided to me. Water Heater __ -' --�- _--
Water S_Q,rv{Le i Electrical f
I am exempt u•ldrr SeCl,r,n -- - -^•---- B.L f C.,for this rC35nn _•�
M:•utiaafcal f
R0..ncr litlfY�.ch _- ..- - - DEVELOPMENT SERYILESREQUIRECENTS: 402
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CITY OF 1.41W ELSINORE
BUILDING DIVISION
O W N E R - B U I L D E R V E R I F I C A T I O N
d
A city or county, which is required to give notice pursuant to
Section 19830, shall attach to such notice, and, as a condition precedent
to issuing a building permit, require the completion and require the return
of an owner.-builder verification.
Attention. Property Owner:
An "owner-builder" building permit has been applied for in your name
and bearing your signature. No buildina permit will be issued until this
verification is received.
?. I personally plan to provide the major labor and materials ,
for construction of the proposed property improvement.
-Yes No
2. I (havee-have not) ��'}Q _ signed an application for a
bui ng permi.t for tWee proposed work.
3. I have contracted w th the following person (firm) to
provide the proposed c nstruction:
Name &/ —
Address
P',.one ( ) Contractors Lic. #
4. I plan to provide portions of the work, but I have hired the
following person to coordinate, super-fise, and provide the
major work: _
Name
Address _
Phone (714) Contractor's Lic. #
5. I will provide some of the work but I have contracted
(hired) the following persons to provide the work indicated:
Name Address Phone Type of Work
f additional space is required att
(I ach subcontractors list. )
1 hereby affirm that I have received a copy of the information set
forth in Section 19830 of the State of California Health and Safety Code
and have complete the above information to -the best of my personal
knowledge, in compliance with this State Law.
signed: ;[ u.v� � � Date:
Name: D —
(Printed or Typed) 11"� 11
Drivers Lic. # or Soc. Sec.